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In this video, we present a new method of tension-free thyroidectomy (TFT). The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive complete dissection of Berry's ligament. The operation was performed under general anesthesia with endotracheal intubation. Patients were placed in a supine position without neck extension. A 35-40 mm horizontal skin incision was made 1 cm above the sternal notch. Subcutaneous fat and platysma muscle were dissected. The linea alba was incised longitudinally for 4–5 cm. When the isthmus capsule was exposed, the last was divided in the middle. Full mobilization of the isthmus and thyroid lobe from the trachea by dissecting the Berry's ligament was performed. Intermitted neuromonitoring (5 mA, Inomed C2) was used to guide the division of fibers of the Berry's ligament. By using the pinnate the thyroid lobe was retracted into the lateral direction (only lateral traction of the thyroid lobe was used during the operation). The mobilization of the thyroid lobe from the trachea was completed by the division of small branches of the inferior thyroid artery and vein. The main branch of the inferior thyroid artery and vein were preserved along with the vessels supplying the parathyroid glands. After complete separation of the thyroid lobe and inferior thyroid vessels from the trachea the recurrent laryngeal nerve was identified and dissected. Also from the medial side, the upper and lower parathyroid glands and their vessels were identified and fully separated from the thyroid capsule. The lower pole of the lobe was pulled out of the thyroid bed. Finally, after neuromonitoring of the superior laryngeal nerve, the upper pole vessels were dissected and divided. In case a total thyroidectomy the same procedure was performed on the contralateral side after vagus stimulation (V2).
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